Background: Handball is a sport with a high number of severe injuries.The shoulder is one of the most commonly injured joints, with an average prevalence of 17–41%.Objective: The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies.Methods: Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results.Results: 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50–85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player’s position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1).Conclusion: Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies.Protocol registration:PROSPERO ID: CRD42020138233.

Purpose: The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon—VISA‐A, greater trochanteric pain syndrome—VISA‐G, proximal hamstring tendinopathy—VISA‐H, patellar tendon—VISA‐P).Methods: A systematic review was conducted according to Consensus‐based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis.Results: There is moderate‐quality evidence for sufficient VISA‐A, VISA‐G, and VISA‐P reliability. There is moderate‐quality evidence for sufficient VISA‐G and VISA‐P measurement error, and high‐quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high‐quality evidence exists with regard to VISA‐A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions.Conclusions: Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA‐A which displayed insufficient measurement error.Level of evidence: IV.Registration details: Prospero (CRD42018107671); PROSPERO reference—CRD42019126595.

Purpose: The Victorian Institute of Sport Assessment (Achilles tendon—VISA‐A, greater trochanteric pain syndrome—VISA‐G, proximal hamstring tendinopathy—VISA‐H, patellar tendon—VISA‐P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross‐cultural validity evidence. The measurement properties referring to content, structural and cross‐cultural validity of the VISA questionnaires were appraised and synthesized.Methods: The systematic review was conducted according to Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross‐cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross‐cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis.Results: The VISA‐A presented very‐low‐quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA‐G displayed moderate‐quality evidence for sufficient comprehensibility and very‐low‐quality evidence of sufficient relevance and comprehensiveness. The VISA‐P presented very‐low‐quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA‐H presented very‐low evidence of insufficient content validity. VISA‐A displayed low‐quality evidence for structural validity concerning unidimensionality and internal structure, while VISA‐H presented low‐quality evidence of insufficient unidimensionality. The structural validity of VISA‐G and VISA‐P were indeterminate and inconsistent, respectively. Internal consistency for VISA‐G, VISA‐H, and VISA‐P was indeterminate. No studies evaluated cross‐cultural validity, while measurement invariance across sexes was assessed in one study.Conclusions: Only very‐low‐quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies.Level of evidence: IV.Registration: PROSPERO reference—CRD42019126595.

Patients with multiple sclerosis (MS) are characterized by, among other symptoms, impaired functional capacity and walking difficulties. Polyunsaturated fatty acids (PUFAs) have been found to improve MS patients’ clinical outcomes; however, their effect on other parameters associated with daily living activities need further investigation. The current study aimed to examine the effect of a 24-month supplementation with a cocktail dietary supplement formula, the Neuroaspis^TM PLP10, containing specific omega-3 and omega-6 PUFAs and specific antioxidant vitamins on gait and functional capacity parameters of patients with MS. Fifty-one relapsing-remitting MS (RRMS) patients with low disability scores (age: 38.4 ± 7.1 years; 30 female) were randomized 1:1 to receive either a 20 mL daily dose of the dietary formula containing a mixture of omega-3 and omega-6 PUFAs (12,150 mg), vitamin A (0.6 mg), vitamin E (22 mg), and γ-tocopherol (760 mg), the OMEGA group (n = 27; age: 39 ± 8.3 years), or 20 mL placebo containing virgin olive oil, the placebo group (n = 24; age: 37.8 ± 5.3 years). The mean ± SD (standard deviation) Expanded Disability Status Scale (EDSS) score for the placebo group was 2.36 and for the OMEGA group 2.22. All enrolled patients in the study were on Interferon-β treatment. Spatiotemporal gait parameters and gait deviation index (GDI) were assessed using a motion capture system. Functional capacity was examined using various functional tests such as the six-minute walk test (6MWT), two sit-to-stand tests (STS-5 and STS-60), and the Timed Up and Go test (TUG). Isometric handgrip strength was assessed by a dynamometer. Leg strength was assessed using an isokinetic dynamometer. All assessments were performed at baseline and at 12 and 24 months of supplementation. A total of 36 patients completed the study (18 from each group). Six patients from the placebo group and 9 patients from the OMEGA group dropped out from the study or were lost to follow-up. The dietary supplement significantly improved the single support time and the step and stride time (p < 0.05), both spatiotemporal gait parameters. In addition, while GDI of the placebo group decreased by about 10% at 24 months, it increased by about 4% in the OMEGA group (p < 0.05). Moreover, performance in the STS-60 test improved in the OMEGA group (p < 0.05) and there was a tendency for improvement in the 6MWT and TUG tests. Long-term supplementation with high dosages of omega-3 and omega-6 PUFAs (compared to previous published clinical studies using PUFAs) and specific antioxidant vitamins improved some functional capacity and gait parameters in RRMS patients.

Objectives: Deficits in proprioception and postural control are common in patients with different musculoskeletal pain syndromes. It has been proposed that pain can negatively affect proprioception and postural control at a peripheral level, however research is limited to animal studies. Human studies have shown that it is more likely, that the link between pain and proprioceptive deficits, lies within changes in the central nervous system where noxious and non-noxious stimuli may overlap. In clinical studies, causality cannot be determined due to other factors which could confound the assessment such as pathophysiological features of the underlying musculoskeletal disorder and different psycho-social influences especially in patients with chronic pain. On the other hand, experimentally induced pain in healthy participants is able to control most of these confounding factors and perhaps offers an assessment of the effects of pain on proprioception and postural control. The aim of this paper is to critically appraise the literature related to the effect of experimentally induced pain on proprioception and postural control. Results from these studies are discussed and limitations are highlighted for future research. Methods: A search of databases (Medline, Scopus, PubMed) was conducted as well as reference check from relevant articles published since 2000. Fifteen studies which explored the effect of experimentally induced pain on postural control and ten studies which explored the effect of experimentally induced pain on proprioception were included. Results: We found that in the majority of the studies, postural control was negatively affected by experimentally induced pain. Results for proprioception were mixed depending on the body region and the way the painful stimuli were delivered. Kinesthesia was negatively affected in two studies, while in one study kinesthesia was enhanced. Joint position sense was not affected in four out of five studies. Finally, force sense was affected in three out of four studies. Conclusions: From a clinical point of view, findings from the available literature suggest that experimentally induced pain impairs postural control and could potentially increases the risk for falls in patients. Interventions aiming to reduce pain in these patients could lead to preservation or improvement of their balance. On the other hand, the same conclusion cannot be drawn for the effect of experimentally induced pain on kinesthesia and joint position sense due to the limited number of studies showing such an effect.

Obstructive sleep apnea (OSA) is the most prevalent sleep disorder caused by breathing difficulties, characterized by repeated episodes of airway blockage while sleeping. Various interventions have been used to improve the symptoms and overall health of individuals with OSA. However, few studies have focused on the impact of exercise on OSA. Objectives: The objective of this review was to evaluate the impact of exercise on individuals with OSA, providing an update on the exercise management of OSA. Methods: This review examined the current literature, including experimental studies and systematic reviews with meta-analysis, that investigated the impact of exercise (oropharyngeal exercises, respiratory muscle training, and therapeutic exercise training) in OSA patients. Studies were identified by searching databases (PubMed, CHINAL, EBSCO) using the following keywords: obstructive sleep apnea, OSA, exercise, oropharyngeal exercises, respiratory muscle training. Inclusion criteria were based on the PICO framework. Results: Forty-three studies were included in this review following the original search, all of which investigated the effects of exercise interventions in OSA. Most of the studies observed various significant health-related improvements following exercise interventions; however, none of them combined or compared all these exercise regimes together. In addition, there is limited information regarding the impact of exercise on sleep architecture. Conclusions: Overall, the findings suggest that exercise, regardless of its regime, benefits individuals with OSA.